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Iúdice TNDS, da Conceição ML, de Brito AC, de Souza NM, Mesquita CR, Guimarães RJDPSE, Furlaneto IP, Saboia ADS, Lourenço MCDS, Lima KVB, Conceição EC. The Role of GeneXpert ® for Tuberculosis Diagnostics in Brazil: An Examination from a Historical and Epidemiological Perspective. Trop Med Infect Dis 2023; 8:483. [PMID: 37999602 PMCID: PMC10674801 DOI: 10.3390/tropicalmed8110483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
The rapid molecular test (RMT) performed on the GeneXpert® system is widely used as a control strategy and surveillance technique for tuberculosis (TB). In the region of the Americas, TB incidence is slowly increasing owing to an upward trend in Brazil, which is among the high TB-burden countries (HBCs), ranking in the 19th position. In this context, we aimed to (i) describe the implementation and history of RMT-TB (Xpert® MTB/RIF and Xpert® MTB/RIF Ultra) in Brazil; (ii) to evaluate the national RMT laboratory distribution, TB, and resistance to RIF detection by RMT; and (iii) to correlate these data with Brazilian TB incidence. The quantitative data of Xpert® MTB/RIF and Xpert® MTB/RIF Ultra assays performed in the pulmonary TB investigation from 2014 to 2020 were provided by the Brazilian Ministry of Health. A spatial visualization using ArcGIS software was performed. The Southeast region constituted about half of the RMT laboratories-from 39.4% to 45.9% of the total value over the five regions. Regarding the federal units, the São Paulo state alone represented from 20.2% to 34.1% (5.0 to 8.5 times the value) of RMT laboratories over the years observed. There were significant differences (p < 0.0001) in the frequency of RMT laboratories between all years of the historical series. There was an unequal distribution of RMT laboratories between Brazilian regions and federal units. This alerts us for the surveillance of rapid molecular detection of TB in different parts of the country, with the possibility of improving the distribution of tests in areas of higher incidence in order to achieve the level of disease control recommended by national and worldwide authorities.
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Affiliation(s)
- Tirça Naiara da Silva Iúdice
- Programa de Pós-Graduação Biologia Parasitária na Amazônia, Universidade do Estado do Pará, Belém-Pará 66087-670, PA, Brazil; (T.N.d.S.I.); (C.R.M.)
| | | | - Artemir Coelho de Brito
- Coordenação-Geral de Vigilância da Tuberculose, Micoses Endêmicas e Micobactérias Não Tuberculosas—CGTM, Ministério da Saúde, Brasília 70000-000, DF, Brazil; (A.C.d.B.)
| | - Nicole Menezes de Souza
- Coordenação-Geral de Vigilância da Tuberculose, Micoses Endêmicas e Micobactérias Não Tuberculosas—CGTM, Ministério da Saúde, Brasília 70000-000, DF, Brazil; (A.C.d.B.)
| | - Cristal Ribeiro Mesquita
- Programa de Pós-Graduação Biologia Parasitária na Amazônia, Universidade do Estado do Pará, Belém-Pará 66087-670, PA, Brazil; (T.N.d.S.I.); (C.R.M.)
| | | | | | - Alessandra de Souza Saboia
- Laboratório de Bacteriologia e Bioensaios em Micobactérias, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil; (A.d.S.S.); (M.C.d.S.L.)
| | - Maria Cristina da Silva Lourenço
- Laboratório de Bacteriologia e Bioensaios em Micobactérias, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil; (A.d.S.S.); (M.C.d.S.L.)
| | - Karla Valéria Batista Lima
- Programa de Pós-Graduação Biologia Parasitária na Amazônia, Universidade do Estado do Pará, Belém-Pará 66087-670, PA, Brazil; (T.N.d.S.I.); (C.R.M.)
- Seção de Bacteriologia e Micologia, Instituto Evandro Chagas, Ananindeua 67030-000, PA, Brazil;
| | - Emilyn Costa Conceição
- Pós-Graduação em Pesquisa Clínica e Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro 67030-000, RJ, Brazil
- Department of Science and Innovation–National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
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Guillouzouic A, Gaudart A, Tessier E, Risso K, Hamdad F, Alauzet C, Vaillant P, Koebel C, Kassegne L, Chenouard R, Abgueguen P, Le Brun C, Jamard S, Lecomte R, Lefebvre M, Bémer P. Xpert MTB/RIF Ultra Trace Results: Decision Support for the Treatment of Extrapulmonary Tuberculosis in Low TB Burden Countries. J Clin Med 2023; 12:jcm12093148. [PMID: 37176590 PMCID: PMC10179111 DOI: 10.3390/jcm12093148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES Extrapulmonary tuberculosis (EPTB) can be difficult to diagnose, especially in severe forms. The Xpert MTB/RIF Ultra test introduced an additional category called trace to reference very small amounts of Mycobacterium tuberculosis complex (MTBC) DNA. The objective of our multicenter study was to evaluate whether the trace result on an extrapulmonary (EP) sample is a sufficient argument to consider diagnosing tuberculosis and starting treatment, even in severe cases. METHODS A retrospective, multicenter cohort study was conducted from 2018 to 2022. Patients strongly suspected of EPTB with a trace result on an EP specimen were included. Hospital records were reviewed for clinical, treatment, and paraclinical data. RESULTS A total of 52 patients were included, with a severe form in 22/52 (42.3%) cases. Culture was positive for MTBC in 33/46 (71.7%) cases. Histological analysis showed granulomas in 36/45 (80.0%) cases. An Ultra trace result with a presumptive diagnosis of TB led to the decision to treat 41/52 (78.8%) patients. All patients were started on first-line anti-TB therapy (median duration of 6.1 months), with a favorable outcome in 31/35 (88.6%) patients. The presence of a small amount of MTBC genome in EPTB is a sufficient argument to treat patients across a large region of France.
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Affiliation(s)
| | - Alice Gaudart
- Department of Microbiology, Nice University Hospital, 06000 Nice, France
| | - Eve Tessier
- Department of Microbiology, Nantes University Hospital, 44093 Nantes, France
| | - Karine Risso
- Department of Infectious Diseases, Nice University Hospital, 06000 Nice, France
| | - Farida Hamdad
- Department of Microbiology, Nancy University Hospital, 54035 Nancy, France
| | - Corentine Alauzet
- Department of Microbiology, Nancy University Hospital, 54035 Nancy, France
| | - Pierre Vaillant
- Pulmonary Department, Nancy University Hospital, 54035 Nancy, France
| | - Christelle Koebel
- Department of Microbiology, Strasbourg University Hospital, 67091 Strasbourg, France
| | - Loïc Kassegne
- Pulmonary Department, Strasbourg University Hospital, 67091 Strasbourg, France
| | - Rachel Chenouard
- Department of Microbiology, Angers University Hospital, 49000 Angers, France
| | - Pierre Abgueguen
- Department of Infectious Diseases, Angers University Hospital, 49000 Angers, France
| | - Cécile Le Brun
- Department of Microbiology, Tours University Hospital, 37081 Tours, France
| | - Simon Jamard
- Department of Infectious Diseases, Tours University Hospital, 37081 Tours, France
| | - Raphaël Lecomte
- Department of Infectious Diseases, Nantes University Hospital, 44095 Nantes, France
| | - Maeva Lefebvre
- Department of Infectious Diseases, Nantes University Hospital, 44095 Nantes, France
| | - Pascale Bémer
- Department of Microbiology, Nantes University Hospital, 44093 Nantes, France
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Alexandrino de Souza Pinheiro1 M, Baroni Aurilio1 R, Alice Amaral Ibiapina Parente1,2 A, de Fátima Bazhuni Pombo Sant’Anna2 M, Cristina Cisne Frota1 A, Barroso Hofer2 C, Fernandes de Abreu2 T, Ferreira2 S, Couto Sant’Anna2 C. Clinical forms and diagnosis of tuberculosis in children and adolescents during the COVID-19 pandemic. J Bras Pneumol 2022; 48:e20220240. [DOI: 10.36416/1806-3756/e20220240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The present study aimed to describe the clinical forms and the time taken to diagnose new tuberculosis cases and to statistically analyze the isolated and combined forms of the disease in children and adolescents treated at a university hospital in Rio de Janeiro during the first year of the COVID-19 pandemic in Brazil. Methods: This was a cross-sectional study that used retrospective data on children (0-9 years old) and adolescents (10-18 years old) with pulmonary (PTB), extrapulmonary (EPTB), and combined tuberculosis (PTB + EPTB) followed up at the outpatient clinic from January 2019 to March 2021. Categorical data were analyzed by descriptive statistics and expressed as frequency and proportions. Categorical variables were compared using the Chi-square test, and numerical variables using Student's T-test. Results: A total of 51 cases were included, 63% (32/51) of which comprised patients in the year of the pandemic (group A), while 37% (19/51) were patients attended in previous years (group B). In group A, 19% (6/32) of the patients presented PTB, 59% (16/32) had EPTB, and 31% (10/32) had PTB+EPTB. In group B, 42% (8/19) of the patients presented PTB, 42% (8/19) had EPTB, and 16% (3/19) had PTB+EPTB. Conclusion: Our study revealed more tuberculosis cases in the first year of the pandemic than in the same period of the previous year, with greater variation of sites affected by the disease, including rarer and more severe forms.
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Affiliation(s)
| | - Rafaela Baroni Aurilio1
- 1. Instituto de Puericultura e Pediatria Martagão Gesteira. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | - Ana Alice Amaral Ibiapina Parente1,2
- 1. Instituto de Puericultura e Pediatria Martagão Gesteira. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil. 2. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | | | - Ana Cristina Cisne Frota1
- 1. Instituto de Puericultura e Pediatria Martagão Gesteira. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | - Cristina Barroso Hofer2
- 2. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | | | - Sidnei Ferreira2
- 2. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | - Clemax Couto Sant’Anna2
- 2. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
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